Pregnancies following a treated ectopia vesicae

Background: Reports of pregnancies in patients with ectopia vesicae (bladder exstrophy) have been reported in the literature. Aim: To report two pregnancies in a woman treated for ectopia vesicae. Setting: Departments of Obstetrics and Gynaecology and Urosurgery; Cornwall Regional Hospital; Montego Bay; Jamaica; West Indies. Case report: A 24 year old woman who had ectopia vesicae was treated with closure of the bladder and with ureterosigmoidostomy as a child. She subsequently had two consecutive advanced pregnancies. In the first pregnancy; a macerated male stillbirth was delivered per vaginam and there was no adverse effect on the genitourinary system. She was successfully delivered of a live baby boy in a subsequent second pregnancy by Caesarean section. Conclusion: This case underscores the benefits of supervising such pregnancies

Transverse ureterotomy in open ureterolithotomy.

Open ureterolithotomy is now a seldom performed operation but is still occasionally necessary. We report on the transverse ureterotomy (TU) in this procedure and its effect on reducing morbidity. Results from 100 cases of TU for stone disease since 1976 were compared with those from 50 ureterolithotomies using the standard longitudinal ureterotomy (LU) performed during the same period. The parameters considered were urinary leakage, length of hospital stay and ureteric narrowing as assessed on intravenous urogram at three months. The cases utilizing TU were associated with significantly less urinary leakage, a shorter hospital stay and no ureteric narrowing. Transverse ureterotomy for stone disease significantly reduces the morbidity associated with the operation when utilizing the standard LU. The fear of transecting the ureter may be overcome by good exposure and gentle careful dissection. We suggest that TU be used for open ureterolithotomy.

Transverse ureterotomy in open ureterolithotomy

Open ureterolithotomy is now a seldom performed operation but is still occasionally necessary. We report on the transverse ureterotomy (TU) in this procedure and its effect on reducing morbidity. Results from 100 cases of TU for stone disease since 1976 were compared with those from 50 ureterolithotomies using the standard longitudinal ureterotomy (LU) performed during the same period. The parameters considered were urinary leakage, length of hospital stay and ureteric narrowing as assessed on intravenous urogram at three months. The cases utilizing TU were associated with significantly less urinary leakage, a shorter hospital stay and no ureteric narrowing. Transverse ureterotomy for stone disease significantly reduces the morbidity associated with the operation when utilizing the standard LU. The fear of transecting the ureter may be overcome by good exposure and gentle careful dissection. We suggest that TU be used for open ureterolithotomy

Familial study of prostate cancer in Jamaica.

OBJECTIVES: Rates of prostate cancer in Kingston, Jamaica are extremely high (occurring in more than 300 men out of 100,000 in 1989 to 1993). This article addresses the familial aggregation of prostate cancer in Jamaica. Early evidence for familial prostate cancer was found in the Utah Mormon population. Increased risk of prostate cancer in men with a family history of prostate cancer has been consistently observed in subsequent studies. There have been few studies, however, involving black men, who are known to have an overall higher risk of developing prostate cancer. METHODS: Two hundred sixty-three patients with prostate cancer documented by histology were studied. Two hundred sixty-three age-matched control patients were used for comparison. Extensive pedigrees were obtained for both patients with cancer and controls. Data on other malignancies including lung, breast, colon, stomach, and uterine were also collected. RESULTS: The patients with cancer and the controls were comparable with respect to age and family size. Thirty patients with cancer had a first degree relative (ie, brother, father, or son) with prostate cancer compared to 15 controls. The odds ratio is 2.1 (95% confidence interval 1.1 to 4.4). Nine patients with cancer had a second degree relative (ie, grandfather, grandson, or uncle) affected compared to 3 controls. The odds ratio is 3.1 (95% confidence interval 0.8 to 17.8). There was no statistically significant difference in the rates of any of the other cancers studied. CONCLUSIONS: Familial aggregation of prostate cancer is clearly evident in black Jamaican men. A man with one first degree relative with prostate cancer is twice as likely as the general population to develop prostate cancer. In addition, there may be a statistical difference in the risk of developing prostate cancer if an individual has one second degree relative affected.

Anesthesia penile tumescence test.

This article describes a simple method which we have found useful in helping to diagnose psychogenic impotence.

The anaesthesia penile tumescence test - abstract

A simple method of differentiating organic from psychogenic impotence is important if appropriate therapy is to be offered. Prostatic massage under light anaesthesia was consistently found to produce penile tumescence in ten controls. Tumescence usually started within one minute of the onset of prostatic massage, and progressed to a stage adequate for penetration within three minutes. The penile erection was maintained at least until the patient reached the recovery room. Eleven patients being investigated for impotence were subjected to the procedure in conjunction with hormonal and blood flow studies. All patients had nocturnal penile tumescence (NPT) stamp tests and two of those who failed this and the anaesthesia penile tumescence (APT) test, had nocturnal penile tumescence (NPT) strain gauge tests in the U.S.A. Seven patients had good APT results, two fair and two poor. The four patients who had fair and poor results also failed the NPT stamp tests and the NPT strain gauge test where this was done. APT testing therefore correlates well with the accepted standard NPT test, requires no special expensive equipment and allows polaroid documentation of rigidity instead of increase in circumference as in the NPT test. Polaroid documentation also allows patients to realise their potential and facilitates treatment of psychogenic impotence (AU)

Transverse ureterotomy for calculous disease - abstract

Transverse ureterotomy is compared to the traditional longitudinal ureterotomy for the management of calculous disease. Ninety-five patients had their ureteric stones removed by transverse ureterotomy. Parameters noted were urinary leak time, drain removal time, wound infection, length of hospital stay, need for further surgical procedures to eliminate the urinary leak and ureteric stricturing. These parameters were also compared in fifty patients who had previously had the traditional longitudinal ureterotomy performed. Urinary leak time was less than 24 hours in the transverse group compared to a range from 24 hours to 10 days in the longitudinal group. Time of drain removal was two days in the transverse group of 4 days or more in the longitudinal group. Wound infection occurred in 15 percent of the longitudinal and 5 percent of the transverse group. Hospital stay averaged less than 7 days for the transverse and 9 days for the longitudinal group. Five per cent of the longitudinal group needed a further surgical procedure. The longitudinal group had 3 cases developing ureteric stricture. Transverse ureterotomy is more muscle-splitting than longitudinal ureterotomy which is muscle-cuting. The decreased complication rate and morbidity associated with the transverse ureterotomy also results in a shorter hosital stay and subsequent savings (AU)